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Original articles

Risk factors for deliberate self-harm in young people in rural Sri Lanka: a prospective cohort study of 22,000 individuals

Authors:

Kiyara Fernando ,

Kings College Hospital, London, GB
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Shaluka Jayamanna,

University of Peradeniya, LK
About Shaluka

Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC)

 

Faculty of Medicine, University of Kelaniya

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Manjula Weerasinghe,

University of Peradeniya, LK
About Manjula
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC)
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Chamil Priyadarshana,

University of Peradeniya, LK
About Chamil
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC)
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Rohan Ratnayake,

Ministry of Health, LK
About Rohan
Directorate of Mental Health
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Melissa Pearson,

University of Peradeniya, GB
About Melissa

Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC)

 

Centre for Pesticide Suicide Prevention, University of Edinburgh, UK

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David Gunnell,

University of Peradeniya, GB
About David

Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC)

 

Bristol Medical School; Population Health Sciences, University of Bristol, UK

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Andrew Dawson,

University of Peradeniya, AU
About Andrew

Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC)

 

Sydney Medical School, University of Sydney, Australia

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Keith Hawton,

University of Oxford, GB
About Keith
Centre for Suicide Research, Department of Psychiatry
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Flemming Konradsen,

University of Peradeniya, DK
About Flemming

Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC)

 

Centre for Pesticide Suicide Prevention, University of Edinburgh, UK

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Michael Eddleston,

University of Peradeniya, LK
About Michael

Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC)

 

Centre for Pesticide Suicide Prevention, University of Edinburgh, UK

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Chris Metcalfe,

University of Bristol, GB
About Chris
Bristol Medical School; Population Health Sciences
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Duleeka Knipe

University of Peradeniya, GB
About Duleeka
Faculty of Medicine, South Asian Clinical Toxicology Research Collaboration (SACTRC),
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Abstract

Background: Over 90% of youth suicide deaths occur in low- and middle-income countries. Despite this relatively little is known about risk factors in this context.


Aims: Investigate risk factors for deliberate self-harm (non-fatal) in young people in rural Sri Lanka.


Methods: A prospective cohort study of 22,401 individuals aged 12-18 years with complete data on sex, student status, household asset score, household access to pesticides and household problematic alcohol use. Deliberate self-harm was measured prospectively by reviewing hospital records. Poisson regression estimated incidence rate ratios (IRRs) for the association of risk factors with deliberate self-harm.


Results: Females were at higher risk of deliberate self-harm compared to males (IRR 2.05; 95%CI 1.75 – 2.40). Lower asset scores (low compared to high: IRR 1.46, 95%CI 1.12 - 2.00) and having left education (IRR 1.61 95%CI 1.31 – 1.98) were associated with higher risks of deliberate self-harm, with evidence that the effect of not being in school was more pronounced in males (IRR 1.94; 95%CI 1.40 – 2.70) than females. There was no evidence of an association between household pesticide access and deliberate self-harm risk, but problematic household alcohol use was associated with increased risk (IRR 1.23; 95%CI 1.04 – 1.45), with evidence that this was more pronounced in females than males (IRR for females 1.42; 95%CI 1.17 – 1.72). There was no evidence of deliberate self-harm risk being higher at times of school exam stress.


Conclusion: Indicators of lower socioeconomic status, not being in school, and problematic alcohol use in households, were associated with increased deliberate self-harm risk in young people.

DOI: https://doi.org/10.4038/cmj.v66i2.9469
How to Cite: Fernando, K., Jayamanna, S., Weerasinghe, M., Priyadarshana, C., Ratnayake, R., Pearson, M., Gunnell, D., Dawson, A., Hawton, K., Konradsen, F., Eddleston, M., Metcalfe, C. and Knipe, D., 2021. Risk factors for deliberate self-harm in young people in rural Sri Lanka: a prospective cohort study of 22,000 individuals. Ceylon Medical Journal, 66(2), pp.87–95. DOI: http://doi.org/10.4038/cmj.v66i2.9469
Published on 20 Dec 2021.
Peer Reviewed

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